Comparing Prostate Cancer Risk Calculators and Decision Strategies for Avoiding Unnecessary Biopsies

What is it about?

The study compared different biopsy decision support tools available to help urologists avoid unnecessary prostate biopsies. The Van Leeuwen model and the Rotterdam Prostate Cancer Risk Calculator performed the best among the multivariable models, with the highest clinical utility. Even in a high-risk cohort, these models could avoid many biopsies while missing very few cases of clinically significant prostate cancer. The study suggests a biopsy threshold of 5%-20% to recommend biopsy, depending on a complete assessment of benefits and harms for each patient.

Featured Image

Why is it important?

This research is important because it compares the performance of various decision support tools currently available to help urologists avoid unnecessary prostate biopsies. These tools could help avoid many unnecessary biopsies while missing few cancer cases. This study found that the Van Leeuwen model performed the best, followed by the Rotterdam Prostate Cancer Risk Calculator (RPCRC). Key Takeaways: 1. The Van Leeuwen model and the RPCRC had the best discriminative ability in predicting clinically significant prostate cancer. 2. Decision curve analysis showed the highest clinical utility for the Van Leeuwen model, followed by the RPCRC. 3. The best multivariable models outperformed all dichotomous decision strategies and models based only on MRI-findings and PSAD. 4. A risk threshold of 5-20% should be used to recommend biopsy, and the appropriate threshold depends on a complete assessment of benefits and harms for a given patient. 5. The study found that MRI-RCs could reduce the number of unnecessary prostate biopsies significantly, at little risk of missing csPCa.